脑卒中患者创伤后应激障碍影响因素的Meta分析

Meta-analysis of factors aff ecting post-traumatic stress disorder in stroke patients

目的 探讨脑卒中患者发生创伤后应激障碍的影响因素,为脑卒中患者创伤后应激障碍的预防和干预提供循证医学证据。方法 计算机检索CNKI、Wanfang、VIP、CBM、PubMed、Web of Science、Cochrane Library、Embase,筛选关于脑卒中患者发生创伤后应激障碍影响因素的相关研究,检索时限为建库至2023年5月。横断面研究采用美国卫生保健质量和研究机构评价标准进行质量评价,病例对照研究和队列研究采用纽卡斯尔-渥太华量表(NOS)进行评价。采用RevMan 5.4软件进行Meta分析。结果最终纳入7篇文献,文献质量评价为中高质量;共纳入446例脑卒中后创伤后应激障碍患者,Meta分析结果显示,卒中后后遗症(OR=1.90,95%CI:1.66~2.17)、合并症(OR=1.30;95%CI:1.12~1.51)、复发性卒中或TIA史(OR=1.38,95%CI:1.10~1.72)、婚姻状况(OR=1.96,95%CI:1.20~3.21)、自费支付(OR=1.68,95%CI:1.00~2.84)、低收入(OR=1.94,95%CI:1.03~3.65)是脑卒中患者发生创伤后应激障碍的危险因素。结论 卒中后后遗症、合并症、复发性卒中或TIA史、婚姻状况、自费支付、低收入是脑卒中患者发生PTSD的危险因素。医护人员应早期识别脑卒中后PTSD高危患者,采取针对性措施预防,减少脑卒中患者创伤后应激障碍的发生和发展,改善脑卒中患者的预后。

Objective To explore the influencing factors of post-traumatic stress disorder(PTSD)in stroke patients,to provide evidence-based medical evidence for the prevention and intervention of PTSD in stroke patients.Methods Computerized searches of CNKI,Wanfang,VIP,CBM,PubMed,Web of Science,Cochrane Library,and Embase were performed to screen relevant studies on the factors influencing the occurrence of PTSD in stroke patients with a search timeframe of the establishment of the library to May 2023.Cross-sectional studies were evaluated for quality by using the US Agency for Healthcare Quality and Research evaluation criteria,and case-control studies and cohort studies were evaluated by using the Newcastle-Ottawa Scale(NOS).Meta-analysis was performed by using RevMan 5.4 software.Results 7 papers werefinally included,and the quality of the literature was evaluated as medium to high quality.446 patients with posttraumatic stress disorder after stroke were included,and the results of Metaanalysis showed that post-stroke sequelae(OR=1.90,95%CI:1.66-2.17),comorbidities(OR=1.30;95%CI:1.12-1.51),and history of recurrent stroke or TIA(OR=1.38;95%CI:1.10-1.72),marital status(OR=1.96;95%CI:1.20-3.21),out-of-pocket payment(OR=1.68;95%CI:1.00-2.84),and low income(OR=1.94;95%CI:1.03-3.65)were the risk factors for the development of PTSD in stroke patients.Conclusion Post-stroke sequelae,comorbidities,history of recurrent stroke or TIA background,marital status,out-of-pocket payment,and low income were risk factors for PTSD in stroke patients.Healthcare professionals should identify high-risk patients with post-stroke PTSD at an early stage and take targeted measures to prevent it,reduce the occurrence and development of post-traumatic stress disorder in stroke patients,and improve the prognosis stroke patients.